Development and Validation of a Novel Instrument to Measure the Community Well-Being of Residency Programs

The Drivers and Barriers of Clinical Health Professions Student Flourishing: An Integrative Review

INTRODUCTION

To determine the drivers and barriers to flourishing for clinical health professions students through a review of peer-reviewed literature.

METHODS

Articles were analyzed in Scopus, PubMed, and EBSCOHost and hand-searched education journals through May 2024 describing flourishing among clinical health professions students. Whittemore and Knafl's integrative approach was used, and quality was assessed by the Mixed Methods Appraisal Tool.

RESULTS

The 26 articles included medical (14/26, 53.8%), pharmacy (8/26, 30.8%), physician assistant (3/26, 11.5%), and nurse anesthetist (1/26%, 3.8%) students. Results were framed by the Social Ecological Model. Individual drivers included meaningful work, feeling valued, and pride in overcoming challenges, while barriers included feelings of self-sacrifice to achieve success. Intrinsic factors were both drivers and barriers (eg, positive affect was positively correlated with flourishing). Interpersonal drivers included feelings of belonging, social relationships, and mentorship, while scheduling conflicts was a barrier. Organizational drivers included integrated wellness efforts and faculty buy-in, while barriers included inadequate recovery time between demanding tasks, required participation in activities perceived to have individual low-value, and resource inaccessibility/insufficiency. There was a deficit in the exploration of the impact of communities, public policy, and race and/or ethnicity on flourishing.

DISCUSSION

Limitations include possible exclusion of relevant articles due to search term and database selection. Students, faculty, and programs are cocreators of environments that promote or thwart flourishing. Educators can intentionally create learning environments that promote flourishing through increasing student autonomy, implementing community-building activities, and developing individual values in the context of training.

Supporting a Culture of Wellness: Examining the Utility of the Residency Program Community Well-Being Instrument in the Medical Training and Work Environment

Physicians are experiencing symptoms of burnout at unprecedented rates. It is essential to assess programmatic factors contributing to physician burnout as actionable items for work climate improvement. Creation of an evidence base of strategies and methods to cultivate a culture of wellness requires iterative assessment, program development and implementation, and evaluation. To serve their function optimally, assessment tools need to be reliable, valid, and sensitive to change. In this Invited Commentary, the authors discuss Vermette and colleagues' report on the Residency Community Well-Being (RCWB) instrument. The authors examine the utility of the RCWB, a novel, validated tool that quantifies the subjective community well-being of an individual residency program and has 3 subscales that measure key aspects of interpersonal interactions among residents, with emphasis on those within the program leadership sphere of influence. The commentary authors recommend further validation of the RCWB, but acknowledge the instrument is a useful contribution to currently available measures in the domains of community well-being, workplace climate, and culture of wellness. Workplace interventions focused on community well-being or culture of wellness are particularly salient ethical and educational priorities for medical training programs. Prioritizing community well-being will help nurture trainees as an investment in the future of medical care, rather than an exploitable resource valued primarily for short-term work demands.